Resumo Fundamento A ocorrência de fístula atrioesofágica após o procedimento ode ablação de fibrilação atrial (FA) continua uma preocupação. Não existe uma abordagem padronizada para minimizar seus riscos e mortalidade. Objetivos Apresentar a experiência de sete anos de um monitoramento endoscópico sistemático de lesão esofágica após a ablação de FA por cateter. Métodos Estudo unicêntrico retrospectivo de avaliação endoscópica sistemática após ablação e FA em procedimentos consecutivos realizados entre 2016 e 2022. Um valor de p < 0.05 foi considerado estatisticamente significativo. Resultados Foram analisados 823 procedimentos de ablação de FA com Esofagogastroduodenoscopia (EGD) de controle. A maioria (n=588; 71,4%) dos pacientes submetidos ao procedimento era do sexo masculino, 575 (69,9%) apresentaram FA paroxística. Monitoramento da temperatura esofágica foi realizada usando um sensor único em 310 pacientes (40,3%) e uma sonda multissensor em 306 (39,8%) pacientes. As lesões estavam presentes em 217 EGD (26,5%): hematoma-equimose em 27 (3,3%), eritema em 14 (1,7%), erosão em 78 (9,5%) e úlcera em 67 (8,2%) pacientes. Nenhuma estratégia de proteção do esôfago foi associada à maior ocorrência de úlceras, com exceção do uso de cateter de ponta de 8mm (14,7% de úlceras com cateter de ponta de 8mm vs. 6,7% com outros cateteres, p = 0,001). Lesões térmicas foram detectadas precocemente e tratadas. A maioria das lesões foi considerada curada na endoscopia, mas um paciente que foi submetido ao isolamento da veia pulmonar com um cateter de ponta de 8mm apresentou fístula esofágica, que foi tratada com sucesso com clipe metálico endoscópico e técnica endoloop. Conclusão A incidência de lesões esofágicas é alta na EGD de rotina realizada após a ablação de FA, embora, na maioria dos casos, sua cura ocorra espontaneamente. Pacientes que se submeteram à ablação com o cateter de ponta de 8mm apresentaram lesões térmicas mais graves. Endoscopia esofágica precoce pode ajudar no diagnóstico de lesões em fases iniciais e a prevenção de fístulas após a ablação de FA.

Abstract Background Atrial-esophageal fistula following AF ablation remains a concern. There is no standardized approach to minimize its risk and morbidity. Objective To present the seven-year experience of a systematic endoscopic surveillance of esophageal injury after AF catheter ablation. Methods This is a retrospective single center registry of systematic endoscopic evaluation after AF ablation in consecutive procedures performed from 2016 to 2022. A p-value of <0.05 was considered statistically significant. Results 823 AF ablation with controlled esophagogastroduodenoscopy (EGD) were analyzed. Most patients (n=588, 71.4%) were male, 575 (69.9%) had paroxysmal AF. Esophageal temperature monitoring was performed using a single sensor in 310 patients (40.3%) and a multi–sensor probe in 306 (39.8%). Lesions were presented in 217 EGD (26.5%): hematoma-ecchymosis in 27 (3.3%), erythema in 14 (1.7%), erosion in 78 (9.5%) and ulcer in 67 (8.2%) patients. No esophageal protective strategy was associated with more ulcers, except the use of 8mm tip-catheter (14.7% of ulcers with 8mm tip catheter vs 6.7% with other catheters, p = 0.001). Thermal lesions were early detected and treated. Most lesions were considered healed at endoscopy, but one patient who underwent pulmonary vein isolation with an 8m tip catheter had esophageal fistula, treated successfully with endoscopic metal clip and endoloop technique. Conclusion The incidence of esophageal lesions at routine EGD following AF ablation is high, although in most of the cases they heal spontaneously. Patients who underwent ablation with the 8mm tip catheter had more severe thermal lesions. Early esophagus endoscopy may help the diagnosis of early-stage lesions and the prevention of fistula formation after AF ablation.

Resumo A técnica estatística de análise de componentes principais foi aplicada para avaliar o desempenho escolar dos Anos Iniciais e Finais do Ensino Fundamental (EF) dos municípios de médio porte do estado do Maranhão, incluindo São Luís, para os anos de 2019 e 2021. Nesse sentido, cinco indicadores educacionais foram utilizados: os percentuais de alunos com aprendizado adequado em Língua Portuguesa (LP) e em Matemática (MAT), os componentes do Ideb e a taxa de distorção idade-série. Nossos resultados mostraram que mais de 90% da variância dos dados originais, para os Anos Iniciais do EF, pode ser essencialmente explicada pelas duas variáveis LP e MAT. Para esta etapa escolar, a pandemia teve impacto significativo na queda desempenho escolar, exceto no município de Timon. Ao contrário dos Anos Iniciais, o modelo estatístico para explicar a variância dos dados para os Anos Finais é mais complexo. Além disso, o impacto da pandemia nesse caso foi menor, com Timon também apresentando crescimento no desempenho. Nossa análise ressalta a disparidade nos efeitos da pandemia entre as etapas escolares e a importância do uso desta técnica na compreensão do desempenho educacional em contextos complexos.

Abstract The principal component analysis statistical technique was applied to assess school performance in the Initial and Final Years of Elementary Education (EE) in medium-sized municipalities in the state of Maranhão, including São Luís, for the years 2019 and 2021. In this sense, five educational indicators were used: the percentage of students with adequate learning in Portuguese Language (LP) and Mathematics (MAT), the components of the Ideb, and the age-grade distortion rate. Our results showed that more than 90% of the variance of the original data, for the Initial Years of EE, can be essentially explained by the two variables LP and MAT. For this school stage, the pandemic had a significant impact on the drop in school performance, except in the municipality of Timon. Unlike the Initial Years, the statistical model used to explain the variance of the data for the Final Years is more complex. Furthermore, the impact of the pandemic was smaller in this case, with Timon also showing growth in performance. Our analysis highlights the disparity in the effects of the pandemic across school stages and the importance of using this technique to understand educational performance in complex contexts.

Resumen Se aplicó la técnica estadística de análisis de componentes principales para evaluar el rendimiento académico de los Años Inicial y Final de la Escuela Primaria (EP) en municipios medianos del estado de Maranhão, incluido São Luís, para los años 2019 y 2021. En este sentido se utilizaron cinco indicadores educativos: los porcentajes de estudiantes con aprendizaje adecuado en Lengua Portuguesa (LP) y Matemáticas (MAT), los componentes del Ideb y la tasa de distorsión edad-grado. Nuestros resultados mostraron que más del 90% de la varianza en los datos originales, para los años iniciales de EP, puede explicarse esencialmente por las dos variables LP y MAT. Para esta etapa escolar la pandemia incidió significativamente en la caída del rendimiento escolar, excepto en el municipio de Timón. A diferencia de los primeros años, el modelo estadístico para explicar la varianza de los datos de los últimos años es más complejo. Además, el impacto de la pandemia en este caso fue menor y Timón también mostró un crecimiento en el desempeño. Nuestro análisis destaca la disparidad en los efectos de la pandemia entre etapas escolares y la importancia de utilizar esta técnica para comprender el desempeño educativo en contextos complejos.

ABSTRACT: Mango (Mangifera indica) production is expanding in many countries, and its discarded residues have the potential to be used in the manufacture of fish diets. This study evaluated replacing part of the corn meal (CM) with mango meal (MM) in diets for piava (Megaleporinus obtusidens) in terms of zootechnical performance, plasma glucose, and intestinal enzymes. Piavas (n = 160) were distributed in a completely randomized design (four treatments and four replications) and were fed for 45 days with diets containing different levels of MM inclusion (0, 33, 66, and 100%). There was no microbiological contamination (mold, total coliforms, Bacillus cereus, and Salmonellasp.) in MM. The MM diet had higher total phenols and total tannins (P < 0.05). Diets with 100% of the CM replaced by MM reduced the growth performance and increased the feed conversion ratio (FCR) and plasma glucose levels in piava (P < 0.05). According to the second-order regression analysis, the optimal level of MM inclusion in the diet estimated based on weight gain and FCR was 23.68 and 19.75%, respectively (P < 0.05). The gradual increase in MM levels replacing CM in the diet reduced the activity of the intestinal enzymes amylase, lipase, and alkaline protease (P < 0.05). In conclusion, we recommended replacing 19.75-23.68% of CM with MM, which can be used in piava diets.

RESUMO: A produção de manga (Mangifera indica) está se expandindo em muitos países e seus resíduos tem o potencial de ser usado para a fabricação de dietas para peixes. Este estudo avaliou a substituição parcial de fubá de milho por farinha de manga (FM) em dietas para piava (Megaleporinus obtusidens) em termos de performance zootécnica, glicose do plasma, enzimas intestinais e análise microbiológica. Piavas (n = 160) foram distribuídas em um esquema completamente randomizado (quatro tratamentos e quatro repetições) e alimentadas por 45 dias com dietas contendo diferentes níveis de inclusão de FM (0, 33, 66 e 100%). Não houve nenhuma contaminação microbiológica (bolor, coliformes totais, Bacillus cereus e Salmonella sp.) na FM. Os fenóis totais e taninos totais foram maiores na dieta com FM (P < 0.05). Dietas com 100% de fubá de milho substituído por MM reduziu a performance de crescimento e aumento a taxa de conversão alimentar (TCA) e os níveis de glicose nos peixes (P < 0.05). De acordo com a análise de regressão de segunda ordem, o nível ideal de inclusão de FM na dieta estimado com base no ganho de peso e o TCA foi de 23,68 e 19,75%, respectivamente (P < 0.05). O aumento gradual dos níveis de FM substituindo fubá de milho na dieta reduziu a atividade das enzimas intestinais amilase, lipase e protease alcalina (P < 0.05). Em conclusão, recomendamos a substituição de 19,75-23,68% de fubá de milho por FM, que pode ser usada nas dietas de piava.

This work evaluated the use of corncob as a support for the immobilization of an extracellular fructosyltransferase (E.C. 2.4.1.9) from Aspergillus oryzae IPT-301, aiming at the synthesis of a stable biocatalyst for the production of fructooligosaccharides. The transfructosylation activity of the immobilized enzyme was maximized via experimental design. Additionally, the biochemical properties and stability of the immobilized enzyme, as well as the reaction kinetics, were determined. The enzyme immobilized on alkali-treated corncob showed the highest transfructosylation activity at 50 °C and pH 5.5. It also presented a wide pH stability and a half-life around 1.4 times greater than the soluble enzyme. Furthermore, the immobilized enzyme showed 53% of retention of catalytic activity in a second consecutive reaction cycle, showing the potential for reuse. These results suggest that alkali-treated corncob is a promising support material for the synthesis of heterogeneous biocatalysts aiming at fructooligosaccharide production, which can contribute to the valorization of this abundant agro-waste.

Serial numbers are marks present on several day-to-day objects, created by manufacturers for purposes such as quality control, product tracking and to prevent counterfeiting. In the case of firearms, these characters can be obliterated or damaged by natural processes or intentionally by criminals to prevent positive identification of stolen property. One non-destructive method employed by crime laboratories for the restoration of obliterated characters is the magnetic particle method. The present work aims to study the synthesis and application of waste-made magnetic nanoparticles in the recovery of adulterated markings. A set of analytical-grade materials and metallic waste magnetic nanoparticles were synthesized for comparison purposes. Chemical characterization tests by X-ray fluorescence, morphological tests by scanning electron microscopy (SEM), and magnetization tests by vibrating sample magnetometer (VSM) were performed. The efficacy of the synthesized nanoparticles was tested on 1020 steel plates previously engraved and adulterated by sanding. Both homemade magnetic nanoparticles demonstrated superior performance compared to commercial magnetic particles. The application of homemade magnetic particles, especially using waste as the source of production, decreases the cost of the material and is environmentally friendly. The development of this material makes magnetic serial number restoration a better option for widespread use in forensic procedures.

Abstract Drill and Blast is one of the most utilized excavation methods due to its cost and adaptation capability. One undesirable feature, however, is the contour shape quality of the blasted cavity. It is usually larger and rougher than planned. This characteristic is related to the crack generated by blasting that propagates until it finds a discontinuity. Some methods for overbreak and roughness control are used but they are far from perfect. One option is to replace explosives with the High-Power Abrasive Water Jet (HPAWJ) Technique for rock cutting the perimeter; a necessary step before execution of the Pre-Splitting Technique. These two techniques can create one free surface, with good roughness, capable of avoiding the crack propagation during the blast process. In this article, through a qualitative comparative research, an adaptive cycle is proposed, based on Drill and Blast, that uses HPAWJ for cutting the perimeter. In addition to the improvement on the tunnel wall roughness, this change can reduce the excavation-damage zone and the overbreak, which leads to a reduction of the amounts of shotcrete and muck, consequently reducing the need for transportation.

Abstract This study carried out a critical review of the principles of radioprotection, including the ALARA, ALADA, and ALADAIP principles. The Google Scholar and PubMed databases were the search resources, and the following keywords were searched: Linear No-Threshold (LNT); Biologic Effects of Ionizing Radiation (BEIR VII); As Low As Reasonably Achievable (ALARA); As Low As Diagnostically Acceptable (ALADA); As Low As Diagnostically Acceptable, being Indication-oriented and Patient-specific (ALADAIP). This critical review included studies with historical references, reviews, position papers, and clinical and experimental studies. Regarding data extraction, only original articles were selected after the screening process. Much of the current evolution of X-ray machines and radioprotection protocols has stemmed from legitimate concerns about this topic. This development has grown out of the relevant work of organizations like ICRP, UNSCEAR, and other renowned international organizations. Low doses of radiation, such as those used for diagnosis, also occur naturally and are present in everyday life. Although there is no agreement on the actual risk involving low doses, the recommendations of ALARA, ALADA, and ALADAIP prevail, in line with the trend to uphold principles that balance the importance of X-ray diagnostic imaging with the intention of keeping the doses as low as possible. The benefits of X-ray exams, when justified, tend to outweigh the low risks attributed to them.

Zirconia-toughened alumina (ZTA) is a promising material for dentistry; however, its current formulation exhibits a mauve coloration. This study aimed to synthesize a white ZTA ceramic by doping it with 0.7 wt% magnesium oxide (MgO). Specimens (1.2 mm in thickness x 12 mm in diameter) were divided into 3 groups (n = 15): ZTA doped with chromium oxide (ZTA-Cr2O3), ZTA doped with MgO (ZTA-MgO) and ICE-Zirkon (control group). The materials were analyzed using X-ray diffraction, energy-dispersive X-ray fluorescence spectrometer, scanning electron microscopy, and spectrophotometer. Biaxial flexural strength was conducted, and the Weibull modulus (m) and probability of failure were calculated. ZTA-MgO group had a white color, showing the pattern for alumina and zirconia grains in ZTA with a typical composition of the materials. It demonstrated superior BFS (915 ±41 MPa) and higher reliability than the ZTA-Cr2O3. ZTA-MgO proved to be able to produce white ZTA for future use in dentistry.

RESUMO As infecções respiratórias são consideradas a principal causa de mortalidade entre as doenças transmissíveis nos indígenas, tornando-se um problema de saúde pública. Este estudo de uma série de casos foi realizado em comunidades indígenas do município de Amaturá (Amazonas, Brasil). Foram analisados 2.728 prontuários de infecções respiratórias do Distrito Sanitário Especial Indígena (DSEI) Alto Rio Solimões. Destes, 52.7% eram do sexo feminino e 76.6% tinham menos de 18 anos. A nasofaringite aguda foi o diagnóstico mais frequente (91.5% dos casos). A faixa etária de 1 a 4 anos apresentou maior frequência de algumas condições. As mulheres apresentaram razão de verossimilhança (RV) significativa com amigdalite aguda não especificada e os homens com laringofaringite aguda. A análise específica da aldeia revelou RV para bronquite aguda por rinovírus em Bom Pastor e bronquite aguda por vírus sincicial respiratório e estreptococo em Nova Itália. Este estudo destaca a alta frequência de infecções respiratórias superiores no maior distrito indígena da Amazônia brasileira, afetando especialmente crianças de 1 a 4 anos. Embora muitas vezes autolimitadas, essas infecções podem levar a problemas respiratórios inferiores mais graves. As descobertas enfatizam a necessidade de medidas preventivas eficazes, melhor acesso à saúde e políticas ambientais para reduzir os impactos da poluição na saúde. O estudo também pede mais pesquisas com melhor representação da diversidade indígena e enfatiza a importância de fortalecer os sistemas de vigilância em saúde e a participação social no planejamento da saúde.

ABSTRACT Respiratory infections are considered the leading cause of mortality among communicable diseases in indigenous populations, becoming a public health issue. This case study was conducted in Amaturá municipality (Amazonas, Brazil) indigenous communities. On total 2.728 medical records for respiratory infections from the Alto Rio Solimões Special Indigenous Health District (DSEI) were analized. Of these, 52.7% were females, and 76.6% were under 18 years old. Acute nasopharyngitis was the most frequent diagnosis (91.5% of cases). The age group 1 to 4 years showed a higher frequency of some conditions. Females showed a significant likelihood ratio (LR) with unspecified acute tonsillitis, and males with acute laryngopharyngitis. The specific analysis of the village revealed LR for acute bronchitis caused by rhinovirus in Bom Pastor, and acute bronchitis caused by respiratory syncytial virus and Streptococcus in Nova Itália. This study highlights the high frequency of upper respiratory infections in the largest indigenous district of the Brazilian Amazon, especially affecting children aged 1 to 4 years. Though often self-limiting, these infections can lead to more severe lower respiratory issues. The findings stress the need for effective preventive measures, better healthcare access, and environmental policies to reduce the health impacts of pollution. The study also calls for more research with better representation of indigenous diversity and emphasizes the importance of strengthening health surveillance systems and social participation in healthcare planning.

Resumo Escores visuais são atribuídos sem considerar uma referência absoluta. Nesse caso, as referências de avaliação são diferentes para cada grupo avaliado, dependendo apenas da estrutura do grupo. Assim, fatores que alteram a estrutura dos grupos de avaliação, como o tamanho do grupo, podem afetar a atribuição do escore visual, bem como a estimação e predição de parâmetros genéticos e valores genéticos aditivos, respectivamente. O objetivo deste estudo é determinar as consequências da atribuição de escores com base em uma referência relativa na estimativa de parâmetros genéticos e valores genéticos aditivos, considerando diferentes tamanhos de grupo de avaliação. Foi realizado um estudo de simulação considerando 6 cenários formados pela combinação de duas populações (selecionadas e não selecionadas) e 3 tamanhos de grupos (10, 40 e 100 animais) para avaliação. Parâmetros e valores genéticos foram estimados usando dois modelos de limiar que diferiram em sua correção para efeitos ambientais. As estimativas de herdabilidade para as duas populações foram próximas quando o modelo corrigiu os efeitos ambientais (0,407 - 0,418). No entanto, os níveis de herdabilidade caíram ao longo das gerações quando o modelo não considerou os efeitos ambientais (0,172 - 0,247). O tamanho do grupo de avaliação afetou principalmente a precisão das predições do valor genético, uma vez que maior precisão estava relacionada a tamanhos de grupo de avaliação maiores (0,576 - 0,715). Concluímos que a forma como os escores visuais são atribuídos não afeta a estimativa de parâmetros e valores genéticos. No entanto, grupos de avaliação de mais de 40 animais devem ser utilizados para obter maior precisão e progresso genético.

Abstract Visual scores are assigned with no basis on an absolute reference. In this case, evaluation references are different for each group, depending only on the structure of the group. Thus, factors that change the structure of evaluation groups, such as group size, can affect visual score assignment, as well as estimation of genetic parameters and prediction of breeding values, respectively. The objective of this study to determine the consequences of assigning scores based on a relative reference on the estimation of genetic parameters and breeding values considering different evaluation group sizes. A simulation study was conducted considering 6 scenarios formed by the combination of two populations (selected and unselected) and 3 group sizes (10, 40, and 100 animals) for evaluation. Genetic parameters and breeding values were estimated using two threshold models that differed in their correction for environmental effects. Heritability estimates for the two populations were close when the model corrected for environmental effects (0.407 - 0.418). However, heritability levels fell over generations when the model did not consider environmental effects (0.172 - 0.247). The size of the evaluation group mainly affected the accuracy of breeding values prediction, since higher accuracy was related to larger evaluation group sizes (0.576 - 0.715). We concluded that the way in which visual scores are assigned does not affect the estimation of genetic parameters and values. However, evaluation groups of more than 40 animals should be used to obtain greater accuracy and genetic progress.

ABSTRACT The development or blending of new products represents a common practice of improvement for the efficiency of existing commercialized fertilizers. The physicochemical characteristics of new formulations differ from those of raw materials. These characteristics directly influence the quality of the fertilizer, as they can alter the storage and application requirements. It is hypothesized that molybdenum (Mo) can be added to urea without affecting urea characteristics and N-(n-butyl) thiophosphoric triamide (NBPT) efficacy. The objective of this study was to characterize the addition of Mo sources and rates to urea treated or not with NBPT at 530 mg per kg of urea. A total of 30 fertilizers were formulated by combining three factors: three types of urea (untreated urea, NBPT-coated urea, and NBPT-incorporated urea), two sources of Mo (ammonium molybdate and Mo trioxide), and five rates of Mo (0, 1.5, 3.0, 6.0 and 12.0 g kg–1 N). Unless the degradation rate of NBPT was not measured, the granules were evaluated in terms of nutrient content salinity, hardness, hygroscopicity, and angle of repose. The physical quality of the fertilizer was affected at Mo rates exceeding 6 g kg–1 N, particularly with soluble Mo sources, resulting in the formation granules with lower hardness and higher hygroscopicity. The addition of ammonium molybdate (Am) was observed to exert a lesser impact on the characteristics of the granules, particularly at Mo rates below 6 g kg–1 N. The interaction between Mo and NBPT remains unclear, and further research is necessary to elucidate the underlying mechanism and the stability of the inhibitor.

RESUMO A palmeira babaçu (A. speciosa), nativa da zona de transição Cerrado-Amazônia, é de vital importância para comunidades agroextrativistas do Nordeste brasileiro, que utilizam subprodutos de seus frutos. Contudo, sua produtividade está em declínio devido a práticas de manejo insustentáveis e perda de habitat. Assim, esta pesquisa teve objetivou estimar parâmetros genéticos relacionados a características de interesse de frutos do babaçu, bem como indicar populações superiores para produção de mesocarpo de coco, acessando populações naturais do Estado do Maranhão, Brasil. Foram amostradas árvores em três localidades de cinco cidades do Maranhão, totalizando 150 indivíduos e 1500 frutos. Foram mensurados o número de cachos e frutos por planta, altura da planta e do estipe, e características morfológicas dos frutos e sementes. Os parâmetros genéticos foram estimados pela metodologia REML/BLUP, pelo Software Selegen. Os caracteres largura do fruto, peso do fruto e peso do mesocarpo apresentaram elevada herdabilidade e acurácia, sugerindo forte influência genética e, que esses caracteres têm potencial para o melhoramento genético da espécie. Os elevados coeficientes de variação relativa observados indicam variação genética suficiente para seleção de genótipos promissores. Frutos amostrados em Coroatá e Buritirana apresentaram melhor desempenho para características para produção. Foram encontradas correlações genotípicas significativas entre vários caracteres de tamanho e peso dos frutos, o que pode simplificar a seleção de genótipos para aumento da produtividade. Este é o primeiro estudo reportando parâmetros genéticos para caracteres de frutos em babaçu, fornecendo informações para seleção de genótipos superiores para programas de melhoramento da espécie.

ABSTRACT Babassu palm (Attalea speciosa) is a native species from the Cerrado-Amazon transition zone with socio-economic importance for agro-extractivist communities in Northeastern Brazil that rely on products derived from its fruits. Babassu productivity is declining due to unsustainable practices and habitat loss. Hence, this research aimed to estimate genetic parameters related to fruit traits of babassu and indicate superior populations for coconut mesocarp production. Babassu trees and fruits were sampled from natural populations in five cities of Maranhão State - Brazil, totaling 150 individuals and 1,500 fruits. The number of bunches and fruits per plant, plant and stipe height, and various fruit and seed morphological traits were measured and used for estimating genetic parameters by the REML/BLUP method with Selegen Software. Fruit width, fruit weight, and mesocarp weight showed high broad-sense heritability and accuracy, suggesting a strong genetic influence and making them excellent candidates for genetic improvement. The high coefficients of relative variation are suitable for selecting promising babassu genotypes. Babassu fruits sampled on Coroatá and Buritirana had the best characteristics for fruit and mesocarp production. We found significant genotypic correlations between various fruit traits (size and weight) that can simplify the selection of high-yield genotypes. Our results are the first report on genetic parameters of important babassu fruit traits, providing valuable data for future breeding programs aiming to increase productivity.

Resumo Os avanços na ressonância magnética cardíaca possibilitaram a caracterização do tecido com alta resolução espacial e de contraste, ao passo que as sequências de realce tardio (RT) de gadolínio contribuíram para a melhoria da detecção da fibrose miocárdica. O padrão de distribuição do RT facilita a diferenciação entre etiologias isquêmicas e não isquêmicas e ajuda a refinar os diagnósticos dentro das cardiomiopatias não isquêmicas, sugerindo fatores etiológicos específicos. Um padrão distinto de RT não isquêmico que ganhou destaque recentemente é o padrão em forma de anel (ring-like), definido como um realce subepicárdico ou circunferencial ou semicircunferencial da parede média, que envolve pelo menos três segmentos contíguos de um mesmo corte no eixo curto. Inicialmente identificado como um marcador de diagnóstico para a desmoplaquina e a filamina C, o padrão foi relatado em condições não genéticas; contudo, continua sendo um achado incomum nessas doenças. Neste artigo, nosso objetivo é apresentar os diagnósticos diferenciais do RT em forma de anel e seus imitadores. A combinação de características epidemiológicas, clínicas, eletrocardiográficas e adicionais permite um refinamento do diagnóstico diferencial do RT em forma de anel.

Abstract Advances in cardiac magnetic resonance have promoted tissue characterization with high spatial and contrast resolution, and late gadolinium enhancement (LGE) sequences have improved the detection of myocardial fibrosis. The distribution pattern of LGE facilitates differentiation between ischemic and nonischemic etiologies and aids in refining diagnoses within nonischemic cardiomyopathies, suggesting specific etiological factors. A distinctive nonischemic LGE pattern that has recently gained prominence is the ring-like pattern, defined as a subepicardial or mid-wall circumferential or semi-circumferential enhancement, which involves at least three contiguous segments within the same short-axis slice. Initially identified as a diagnostic marker for desmoplakin and filamin C-related cardiomyopathies, the pattern has been reported in nongenetic conditions; nevertheless, it remains an uncommon finding in these diseases. In this article, we aim to present the differential diagnoses of ring-like LGE and its mimics. The combination of epidemiological, clinical, electrocardiographic, and additional features enables a focused refinement of the differential diagnosis associated with ring-like LGE.

Resumo Introdução: A tristeza, indicadora de saúde mental fragilizada e fator prognóstico para o suicídio, caracteriza-se por sentimento persistente de desespero por duas semanas ou mais, impactando atividades cotidianas, incluindo atividades físicas. Objetivo: Verificar a interação entre o sexo e o sentimentos de tristeza com o nível de atividade física e o uso do smartphone em adolescentes. Método: Estudo com amostra representativa de 772 adolescentes (52,6% do sexo feminino) com idade média de 16,63±0,69 anos, selecionados em amostragem por estágios múltiplos. O nível de atividade física, o tempo de uso do smartphone e o sentimento de tristeza foram autorreportados. As interações foram verificadas pela regressão logística binária em dois diferentes modelos. Resultados: Foram observadas interações entre meninos e meninas com sentimento de tristeza e o uso do smartphone por mais de duas horas nos dois modelos propostos. No Modelo 1, foram observadas associações com o uso do smartphone por mais de duas horas diárias para meninos com sentimento de tristeza (RC 2,04; IC95% 1,43–2,92), para meninas sem o sentimento de tristeza (RC 1,48; IC95% 1,01–2,17) e com o sentimento de tristeza (RC 2,53; IC95% 1,55–4,11). No Modelo 2 foram observadas associações entre meninos com sentimento de tristeza (RC 2,18; IC95% 1,34–3,53) e meninas com sentimento de tristeza (RC 2,42; IC95% 1,36–4,29). Conclusão: Sentimento de tristeza, independente do sexo, está associado ao maior tempo diário em uso de smartphones pelos adolescentes.

Abstract Background: Sadness, an indicator of weakened mental health and a prognostic factor for suicide, is characterized by a persistent feeling of despair for two or more weeks, affecting daily activities, including physical exercise. Objective: To verify the interaction between sex and feelings of sadness with physical activity level and cell phone use in adolescents. Method: This was a study with a representative sample of 772 adolescents (52.6% female) with a mean age of 16.63±0.69 years, selected in a multi-stage sampling process. Physical activity level, cell phone use and sadness feelings were self-reported. The interactions were verified by binary logistic regression, in two different models. Results: Interactions between boys and girls with sadness feelings and cell phone use for more than two hours were observed in the two models proposed. In Model 1, associations were observed with cell phone use for more than two hours, daily, for boys with sadness feelings (odds ratio — OR 2.04; 95% confidence interval — 95%CI 1.43–2.92), for girls without sadness feelings (OR 1.48; 95%CI 1.01–2.17) and with sadness feelings (OR 2.53; 95%CI 1.55–4.11). In Model 2, associations were observed between boys with sadness feelings (OR 2.18; 95%CI 1.34–3.53) and girls with sadness feelings (OR 2.42; 95%CI 1.36–4.29). Conclusion: Feeling sad, regardless of sex, is associated with daily time spent using cell phones by adolescents.